Case Report

Alcoholic Cardiomyopathy, The Silent Enemy of the Heart: A Case Report

Authors: David Fernando Ortiz-Pérez, Camilo Lopera-Martínez, Daniela López-Quintero, Camila Andrea Veloza-Valcárcel, Jhonatan Rodríguez-Vásquez, Robin Luis Petro-Noriega, María Isabel Arias-Bello, Marianella Molina-Angarita, Jhon Alexander Perez-Sanmiguel, Carlos Mauricio De La Peña Pérez.

DOI: 10.33425/2771-5906.1036

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Abstract

Alcoholic cardiomyopathy is a form of acquired dilated cardiomyopathy associated with chronic, excessive alcohol consumption, defined as more than 80 g/day for a minimum of five years. Its pathophysiology involves activation of the renin–angiotensin–aldosterone system (RAAS) and direct oxidative damage from ethanol, primarily via its main metabolite, acetaldehyde. This metabolite impairs mitochondrial function, promotes fibrosis and apoptosis, and affects structural myocardial proteins such as actin and myosin. Clinically, it presents as heart failure, showing no specific features that distinguish it from other dilated cardiomyopathies. Diagnosis is based on a history of chronic alcohol use, the presence of withdrawal symptoms, and imaging findings particularly on echocardiography. We describe the case of a 55-year-old man with a 25-year history of heavy alcohol intake (AUDIT score of 34), who presented with resting dyspnea, intolerance to lying flat, and mild oppressive chest pain. Physical examination revealed a displaced point of maximal impulse and lower-limb edema. Echocardiography confirmed a dilated cardiomyopathy with a left ventricular ejection fraction of 17%. Other etiologies were excluded through additional tests, including low vitamin B12 levels, negative serology for Chagas disease, and normal coronary angiography, supporting the diagnosis of alcoholic cardiomyopathy. This case underscores the importance of a detailed clinical history and the use of imaging techniques for prompt diagnosis, as well as the toxic impact of chronic alcohol use on the myocardium. Furthermore, ruling out other structural and ischemic causes confirms alcohol as the main etiological factor in the development of this cardiomyopathy.

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